Professional Documents
Culture Documents
Epidemiology Knee Injury Diagnoses and Triage PDF
Epidemiology Knee Injury Diagnoses and Triage PDF
com
The declaration of a special interest in sports medicine and particularly an interest in sports orthopaedics reveals a refer-
ral base which includes knee injury as the most common presentation. Over the next four journal issues, this series will
examine the general pattern of acute injuries followed by the more specific topics of instability, patellar dislocation, patel-
lar tendon lesions, meniscal injury, and articular cartilage defects.
By way of introduction, the first article highlights the magnitude of the problem, the common diagnostic inaccuracy, and
the need for a regional referral structure. It was written by Steve Bollen, who completed an overseas fellowship in sports
orthopaedics and has subsequently been a consultant in knee and ankle surgery at a district general hospital for eight years.
He is involved in the production of Best practice guidelines in ACL reconstruction on behalf of the British Orthopaedic
Association, and has treated many elite athletes mainly from the sports of soccer, rugby, and ballet.
J WEBB
Consultant Orthopaedic Surgeon
Southmead Hospital, Bristol
I CORRY
Consultant Orthopaedic Surgeon
Royal Victoria Hospital, Belfast
In the Western world we live in a society obsessed by sport. however, has produced some interesting information. It is
At recreational level, this allows an escape from the not widely appreciated that ligament damage to the knee is
pressures of modern life, and, at the elite level, sport is now more common than any other type of knee injury pathology
an established part of the entertainment industry, with (fig 1).3 Many medical students, general practitioners, and
enormous material rewards for the participants. At all lev- paramedics may be familiar with the story of a weight
els, injury is a constant threat, and, of all injuries, those of bearing, twisting injury producing a meniscal tear;
the knee fulfil the athlete’s greatest fear of spending a long however, there is generally a profound ignorance about the
time out of action. This is confirmed by a study from Shef- history and signs of the more common (and potentially
field, which showed the knee to have been the most more devastating) ligament injuries. The “miscellaneous
commonly injured joint and soccer and rugby to have the injuries” category takes up a quarter of the total, and this is
highest risks.1 It has been said of our national game that it made up of a selection of pathologies such as contusions of
is not so much a sport as a knee disease! the knee and traumatic bursitis. Projecting from American
Not only may a knee injury require surgery followed by figures, a casualty department covering a population of
months of rehabilitation, but permanent disability from 400 000 should expect to see about 500 significant knee
both sport and work may be the outcome. Indeed, a large injuries a year.
study from Scandinavia found that the most common This begs the question of how they should be assessed
cause of permanent disability following a sports injury was and managed. Any knee injury associated with an eVusion
injury to the knee.2 or haemarthrosis ought to be assessed by an appropriately
There is little work on the pattern of knee injuries in the trained clinician as soon as is practical. Acute injuries can
United Kingdom, although a multicentre study is currently be immobilised in a long leg brace, which should be imme-
in progress. The work that has been carried out abroad, diately available to anyone caring for players in a sport
where knee injury is a possibility. The situation is then
under control, and arrangements for clinical assessment
Miscellaneous Ligament injury can be made. Plain x ray examination is mandatory to
25% 40% exclude fractures and ligamentous avulsion fractures,
which may alter management. Magnetic resonance imag-
ing rarely changes clinical decisions and is not a substitute
for a careful history and examination. It has been shown to
be less sensitive and specific for anterior cruciate ligament
(ACL) injuries than clinical assessment4 and has not been
shown to contribute to operative decision making.5
Prompt management can quickly return a sportsperson
to the playing field. For example, a player with a meniscal
tear can have arthroscopic surgery and return to sport at
three to four weeks after injury. Furthermore, as most of
Patella injury the sportspeople injured are in the wage earning popula-
24%
tion, their time away from employment can be minimised.
Meniscus injury This is cost eVective to society as a whole. At present, how-
11% ever, the player presenting with a knee injury tends to get a
Figure 1 Classification of 1833 knee injuries.1 poor deal. We know that an injury to the ACL is one of the
Downloaded from http://bjsm.bmj.com/ on February 26, 2016 - Published by group.bmj.com
228 Bollen
These include:
References This article cites 5 articles, 4 of which you can access for free at:
http://bjsm.bmj.com/content/34/3/227.2#BIBL
Email alerting Receive free email alerts when new articles cite this article. Sign up in the
service box at the top right corner of the online article.
Notes